Menopause, Perimenopause, and Active Women: What You Need to Know
What Is Perimenopause vs. Menopause?
- Perimenopause is the transition period leading up to menopause and can last 7–10 years, often beginning as early as the late 30s.
- Menopause is officially diagnosed after 12 consecutive months without a menstrual cycle. The average age is around 51, but the range is wide.
During perimenopause, hormones fluctuate unpredictably—often creating symptoms long before periods stop.
Common Perimenopause Symptoms Active Women Notice First
Women—especially endurance athletes and high performers—often dismiss early symptoms as stress or aging. Common signs include:
- Brain fog and forgetfulness (“Is this early dementia?”)
- Sleep disruption, especially 2–4am wakeups
- Increased anxiety or mood changes
- Irregular or heavy menstrual cycles
- Decreased recovery and increased fatigue
- Joint pain or frozen shoulder
These symptoms are often driven by declining progesterone and estrogen, not lack of discipline.
Hormone Therapy: Why Timing Matters
Dr. DeVries reframes hormone therapy with a powerful question:
Why wouldn’t we use hormones—unless there’s a clear reason not to?
Estrogen supports:
- Bone density
- Brain health
- Cardiovascular health
Progesterone supports:
- Sleep quality
- Anxiety regulation
- Uterine protection (if you have a uterus)
Hormones don’t have to wait until menopause. Starting during perimenopause, when symptoms appear, may offer the greatest benefit—especially for bone protection.
Progesterone and Sleep: A Game Changer
One of the most common early interventions Dr. DeVries uses is low-dose oral progesterone, particularly for women experiencing:
- Middle-of-the-night wakeups
- Anxiety spirals
- Poor recovery
Progesterone is typically taken orally, as transdermal absorption is unreliable for uterine protection.
Testosterone for Women: Helpful, But Use Carefully
Women naturally produce testosterone, but levels slowly decline starting in the mid-30s.
Potential benefits (when appropriately dosed):
- Improved libido
- Energy and motivation
- Muscle and bone support (modest)
Important caution: High doses—especially pellets—can cause irreversible side effects such as voice changes, facial hair, acne, and hair thinning.
Dr. DeVries typically uses very low-dose transdermal gel, carefully monitored with labs.
Strength Training Is Non-Negotiable in Midlife
Bone density drops most rapidly just before and after menopause. Hormones alone are not enough.
Key recommendations:
- Progressive overload strength training
- Lifting heavy enough to stimulate bone adaptation
- Not just endurance—muscle is protective
(“Pink three-pound dumbbells are not enough.”)
Longevity Factors Women Must Watch Closely
Beyond hormones, midlife women should prioritize:
- Sleep quality (screen for sleep apnea if snoring or unrested)
- Insulin resistance & blood sugar trends
- Cholesterol and cardiovascular markers
- Vitamin D & calcium intake
- Alcohol reduction (no longer considered protective)
Tools like short-term CGM use can help women learn how their body responds to food and movement—without shame.
Top 3 Takeaways from This Episode
- Hormone therapy is about optimization—not fear. Start with “why not.”
- Strength training + hormones protect bones and performance. You need both.
- Lifestyle still matters: sleep, nutrition, movement, and stress management compound the benefits.
Recommended Books & Experts
- The Menopause Moment – Dr. Kelly Casperson
- Unbreakable – Dr. Vonda Wright
- Perimenopause resources by Dr. Heather Hirsch
About the Guest
Dr. Abby DeVries is a family physician and founder of SABIA Health, a direct primary care practice focused on women in midlife. She provides both in-person and virtual care throughout North Carolina.
Website: sabiahealthnc.com
Social: @sabiahealthnc
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